Rare locations of multiple symmetric lipomatosis (Madelung’s disease)

Introduction

Multiple symmetric lipomatosis (MSL) is a rare disease of unknown etiology, which is characterized by the presence of massive symmetric deposits of unencapsulated fatty deposits around the face, back of the head, neck, upper arms, abdomen, back, and upper leg in a very specific distribution pattern giving the patients a “Michelin Man” resemblance [1, 2]. Because of this characteristic and the absolute symmetry, the condition is often dismissed as simple obesity. The condition often develops over a period of months to years. It is characterized by a steady increase in weight, despite all attempts at dieting, which often leads to the judgment of “a noncompliant patient.” MSL typically affects male patients from the Mediterranean countries aged 30–60 years. The etiology is still not clear, but a history of alcohol abuse is commonly found [2]. Some reports describe autosomal recessive or autosomal dominant inheritance [3, 4], and the association with mitochondrial dysfunction...